Who is dying from heroin-related overdoses?

A breakdown of the heroin-related overdose deaths in York County
Sean Heisey, York Daily Record

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Dr. Chris Echterling, medical director for vulnerable populations for WellSpan, said some people have the perception that the heroin and opioid problem is "just a city problem, or it's … a minority problem," or a young person's problem. That's not true, and that perception could lead to missing people struggling with addiction, he said. Echterling was photographed at WellSpan's York Community Health Center.(Photo: Paul Kuehnel, York Daily Record)Buy Photo

When Alyssa Rohrbaugh travels to small fairs and other events, she takes boards with the names and faces of people killed by heroin and other drugs.

Some who walk by are surprised.

Oh, my God. Look how pretty she is.

Look, he was in the military.

Look at him. Can you believe he was a heroin addict?

"In their minds, they have a picture of what a drug addict is," said Rohrbaugh, of the York chapter of Not One More, a group trying to fight the heroin epidemic. "And it’s not what they just looked at."

An analysis by the York Daily Record/Sunday News of overdose data from the York County coroner's office shows the wide range of people who have suffered the ultimate consequence of heroin and opioid addiction.

Of the 127 people who died in heroin-related overdoses in the area in 2014 and 2015, nearly all – nine out of 10 – were white. Most were men: three out of every four. The median age was 32. The majority – more than seven out of 10 – lived outside York city, based on the home address listed in coroner records.

Physicians, counselors and others who work with people fighting addiction said the numbers match their experiences. But those experts said the numbers emphasize a point that some in the community still don't understand, even now, almost two years after the number of heroin-related overdose deaths more than tripled in York County.

"This crisis is something that is interwoven through the fabric of this entire county. It is not limited to only one place," meaning York city, said Dave Sunday, chief deputy prosecutor for the county and member of a local task force aimed at fighting heroin use and opioid abuse. "This is something that affects everyone, in all walks of life."

If people realize the range, Sunday said, it might help them have a tough conversation with a family member or friend. That could be the difference between someone who lives and overcomes their addiction, and someone who dies.

Dr. Chris Echterling, a family medicine physician and medical director for vulnerable populations for the WellSpan health system, said some people have the perception that the heroin and opioid problem is "just a city problem, or it's … a minority problem," or a young person's problem. That's not true.

"If we have that perception in our mind, we’re actually going to miss people who are ... struggling with addiction and then not be able to help them and their families," Echterling said.

Obituaries for the 127 heroin-related overdoses described military veterans and loving parents. Their interests ranged from surfing to reading to playing guitar.

Some suggested a person died in a drug-related death by noting a struggle with addiction. Other obituaries gave no hint.

One, for instance, described the woman in her 50s as an animal lover and said memorial contributions could be made to The Humane Society of the United States. Another, for a woman in her 60s, said she was survived by grandchildren, among others, and focused on her work history and hobbies.

The ages vary – the YDR analysis of the 127 deaths found that about one out of four people were 40 or older. Rohrbaugh, of Not One More, once met a woman, probably in her 40s, who started using drugs to help her cope with a daughter's death.

Carl Sever, director of clinical development for Pennsylvania Counseling Services, said a certain percentage of the population is always going to be vulnerable to drug addiction of some kind. But he said the damage recently was made worse by the easy availability of cheap and highly addictive drugs.

“That’s a recipe for disaster,” he said.

Healthcare professionals, counselors and others described two common paths to using heroin and fentanyl, a synthetic opioid pain medication that is often used with heroin or as a substitute. People either start using painkillers as a recreational drug, or they start using them to treat a medical condition, and then they move on to heroin, fentanyl or both.

Stacey Burroughs, behavioral health coordinator for Family First Health, said there are factors that can make a person more at risk of drug addiction, such as if they experienced a trauma, have a history of depression or have a blood relative who was addicted to drugs.

But she called addiction "a brain disease" that "doesn’t discriminate."

"It touches people from every culture," Burroughs said.

Changes

This year, 37 people have died in confirmed heroin-related deaths, while another 19 died in suspected heroin-related deaths, York County Coroner Pam Gay said on Monday. Meanwhile, there were about 160 saves by law enforcement using the overdose-reversal drug naloxone through September, according to the York County district attorney’s office.

That drug, which police officers in York County police departments began carrying in 2015, is one example of the changes that have happened in York County and statewide in response to the heroin epidemic.

Pennsylvania Counseling Services and Family First Health, which have offices in York, have both been awarded state grants to be Centers of Excellence in offering treatment to people and help them navigate the healthcare system.

Dr. Debra Bell, director of clinical quality improvement for Family First Health, said the state's new Prescription Drug Monitoring Program, which launched in August, helps medical providers see if patients are going to multiple locations, including emergency departments, to receive painkillers. "That part has been huge," Bell said.

Memorial Hospital and WellSpan, which includes York Hospital, both use that program.

In the spring, WellSpan began rolling out new procedures for treating patients on controlled substances, such as oxycodone and other pain killers. As part of that, patients on those medications are told they should expect to periodically be called into the office for pill counts and urine drug screening to ensure that they aren't giving or selling those medications to others or combining those medications with the wrong drugs.

Those kind of checks have been possible, but rarely happened before, said Echterling, of WellSpan.

Medical providers face two common questions with the new process:

Why are you doing this now?

And why are you treating me like a drug addict? I've never done anything wrong.

The answer to the first question, Echterling said, is that medical providers think opioids are less effective for treating pain and riskier than they thought they were five or 10 years ago.

For the second question, Echterling said, providers make the comparison to child abuse. Pennsylvania lawmakers in recent years have increased background check requirements and passed other legislation aimed at preventing child abuse.

Echterling said most people who use pain medications are not drug abusers.

"But we also have learned we can’t figure out who’s going to get in trouble," Echterling said. "So we’re just going to apply these techniques (to) everybody, because we think they're wise and they're safe. And that way we also are not discriminating against anyone."

Some patients have said the new procedures are too much of a hassle and have asked to be taken off opioid painkillers.

“We’re happy to … oblige them and then figure out something else that will treat them without the need for all the monitoring,” Echterling said.

The new WellSpan procedures are still being rolled out for patients and practices.

Sunday, chief deputy prosecutor and a member of the local heroin task force, said the YDR’s analysis of overdose deaths can help public officials target certain groups for education and outreach.

He said public officials recently noticed that a number of heroin-related overdose deaths occurred after someone had left jail, prison or some other institution where they were prevented from using any drugs. He said York County Prison recently began offering inmates an injectable drug, known as Vivitrol, which blocks the effects of heroin and other opioids​. The injection is meant to last four weeks.

York County Prison Warden Mary Sabol said the drug is given to inmates a few days before being released and they must be willing to participate in drug and alcohol treatment in the community. The voluntary program began in mid-September and seven inmates had received an injection as of Oct. 6, she said.

Sunday pointed to the addition of Vivitrol at the prison as a sign of progress.

"The more we learn about this crisis, the more able we are to put together the most impactful programs to keep people in York County from dying," Sunday said.

Staff writer Gordon Rago contributed to this report.

York County vs. Pennsylvania

York County had one of the highest rates in the state for drug-related overdose deaths in 2014, according to a report from the Drug Enforcement Administration. That report did not make the same statewide comparisons specifically for heroin and fentanyl overdose deaths.

The county's rate of drug-related overdose deaths per 100,000 people in 2014 was 26.77, according to the report. It ranked sixth out of Pennsylvania’s 67 counties.

In 2015, York County's ranking for its drug-related overdose death rate had fallen to 28th out of Pennsylvania’s 67 counties, according to the Drug Enforcement Administration. The drug-related overdose death rate here was 22.35 per 100,000 people.

About the data

Information on the 127 heroin-related overdose deaths in the York Daily Record’s database for 2014-2015 comes from a list provided by York County Coroner Pam Gay and from details available in binders at her office.

Gay also provided some information, such as race or ethnicity, if it was not listed in the binders, and corrected some information, such as conflicting dates of birth.

For some, the cause of death was listed as heroin overdose or heroin toxicity, but for others, the cause of death didn’t specifically mention heroin, or it mentioned drugs in addition to heroin. Some described the cause of death as fentanyl toxicity, mixed drug toxicity or something else. Gay has declined to provide toxicology reports that could shed light on what happened in those cases. She cited health privacy issues.

Gay said pathologists classify some deaths as mixed-drug toxicity because “it is not always easy to tell which drug caused the death, but rather, possibly, a combination did.”

To determine whether a death was a heroin-related overdose, the coroner’s office looks at test results for a person’s blood, urine and eye fluid, Gay said. Investigators for the office also look for clues from the scene, such as needles and heroin bags.

Gay said she made the decision to include fentanyl overdoses as heroin-related deaths after she took office in 2014, because it’s common for people to seek fentanyl as a heroin substitute, or to use fentanyl when they think they are using heroin.

To get help

To find resources if you or a loved one needs help:

The York County Drug & Alcohol Commission recommends calling the White Deer Run Regional Support Center at 1-866-769-6822. You can also search "York County Drug Alcohol Commission" online.